I recently watched a BBC program called “Doctor in the House”, featuring Dr Rangan Chatterjee, a GP in Manchester. He’s a proponent of “Functional Medicine”, a holistic medical approach that is more prevalent in the US and Australia – however, it is gaining more mainstream popularity in the UK.
As the show opens, Dr Chatterjee explains that the 7 minutes allocated for a GP consultation with a patient does not provide enough time to explore and address all the factors contributing to a patient’s complaint. Furthermore, the consultation only addresses factors that a patient is aware of; perhaps more benefit is derived from a GP spending time with the family in the home, dissecting their lifestyles and environment to expose the aetiologies of their problems. To this end, the first episode had Dr Chatterjee move into the home of a North London family – Priti and her partner Sandeep.
The show was met with both criticism and praise on social media, a flippant article on the Guardian website and a BMJ review written by Dr Helen Macdonald (GP and BMJ Associate Editor) describing Dr Chatterjee’s mission of holistic care as a ‘myth’.
One of the areas where Dr Chatterjee came under fire were the investigations he ordered for his subject family.
“Several of the tests raised my eyebrow, such as cortisol sputum tests for stress—really? A scan to demonstrate visceral fat in obesity: what does that change?”
I get her. It seems simple to deduce that if one is fat and stressed, it shouldn’t take a test to see that one may have deranged cortisol and other hormonal markers. Likewise, if one’s waistband and collar size are expanding, a BMI measure or a DEXA scan may not provide groundbreaking insight. So maybe the tests weren’t necessary clinically.
I also understand the concerns that arise:
Are these tests promoting hyper-medicalisation?
What if the lenient use of investigations on public television provokes a surge of members of the public rushing to their GP in hope of an explanation of their current BMI strife?
Could this increase in requests further congest GP practices and accelerate the exponential spiral of NHS spending?
So what benefit do these tests have? What do they change?
“The glitz of the high tech tests overshadowed the unglamorous reality that many of the diagnoses related to lifestyle.”
Agreed! The tests do add glitter to an otherwise dull Primary Care occurrence. But what is the alternative?!
I’m sure that every GP and patient are fed up of “Remember your 5 a day! Don’t forget your 150 minutes a week!” reluctantly added onto the more exciting battery of lifestyle questions focused on Sex, Drugs and Rock ’n’ Roll.
I suspect these lacklustre Physical Activity and Diet soundbites leave little residue in the patient’s memory. Wonder, are the GPs convincing enough to even follow their own advice?
Placing my cynicism aside, I feel these tests were perfectly appropriate in the context of this TV show and that placing medicine in the gaze of the public eye carries many advantages. The tests may not have been essential clinically, they may have been tinted with shades of celebrity, GPs may see a rise in requests – but they have sold important messages of health education to the public.
One of the important messages is that preventative healthcare can be effective and proactively employed by the individual.
Our bodies do not display clinical disease as the first sign. Children can have signs of atherosclerosis – yet they do not present with the signs of cardiovascular disease. They haven’t got our definition of disease yet – but they have the shoots of pathology growing.
We as medics may know the changes are there – but for the public, clinical disease is something they do not usually see coming nor prepare for. A person’s problem with weight doesn’t correlate with a significant fear of early death. In this case, medicalisation can help people recognise the severity of a sign thought of previously as ’normal’.
In Priti’s case, the test medicalised her condition enough for her to take control – being more accepting of the prescribed lifestyle changes and acting on them. She lost 5 stones of weight.
What about Sandeep? His huge success with lifestyle changes – eating less, removing junk, increasing physical activity – showed the benefit of these interventions on a person’s health. What could the story have been had a Dr Chatterjee figure stepped in 12 years prior?
Perhaps medicalisation of certain risk factors e.g. obesity/stress etc is beneficial – serving to highlight their importance early and to start necessary lifestyle changes to divert an individual’s course before they present to primary care.
For those interested more in health economics, it would be worth calculating and comparing the costs of the couple’s healthcare. How much does a single test (reinforced with motivational interviewing) compare with the cost of 11+ years of polypharmacy needed to control Sandeep’s chronic Type 2 Diabetes?
Towards the end of the article, Dr Macdonald asked a barrage of questions:
“How sustainable will these changes prove? What effect will Chatterjee’s visits have on new problems? Will these families get better at identifying and managing harmful behaviours? Will they consult differently? Will they be healthier?
Will viewers change their behaviour?”
I can only hope to answer this by using Dr Macdonald’s praise towards Dr Chatterjee’s success exploring the difficult areas of body dysmorphia and opiate dependence.
“And if that prompts patients to access psychological services (A) to understand how self perception and negative thoughts (B) can drive unhelpful behaviour and damage their health, the programme will have been worthwhile.”
What do we get if we edit the above quote?
Primary care Obesity and inactivity, stress, relationships, sleep.
DIeticians Poor nutrition and food choices
Physiotherapists Inactivity, poor mobility, poor balance
My point being – medical TV is a great way to promote education to the public to create positive change, a benefit that could outweigh the negatives – Out of all the people who saw the program how many won’t storm their GPs requesting tests, rather staying unseen, stimulated to act independently, perhaps enacting some of the safe DIY interventions proposed by Dr Chatterjee?
Unfortunately, when I read Dr Macdonald’s review I sense her skepticism of lifestyle interventions in comparison with modern medicine’s more new fangled interventions, a view that I think Dr Chatterjee set out to change.
A series like Dr Chatterjee’s is a pioneering feat – publically promoting lifestyle changes to a family representative of many in the UK. Dr Chatterjee’s approaches had success and the family shared in these successes; I think criticism of an inexpensive and common test as unnecessary and as medicalisation may be an inflated response.
Regarding Priti and Sandeep’s experiences and successes following Dr Chatterjee’s interventions, I can only hope they maintain their efforts. They’ve seen first hand the improvements. In my ideal world, they become local heroes and can use this opportunity to help others make a lifestyle change.
I’m all done! Did you watch the show? What did you think of it? As always, please share your views and feedback with me in the comments below, or connect on social media.
Dr Macdonald’s review on the BMJ. The comments are worth a read!
The Guardian commentary. Let me know what you think.
Another doctor at home series I haven’t watched yet, on Channel 4.